Provider Demographics
NPI:1891993861
Name:MITRUSHINA, MAURA N (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAURA
Middle Name:N
Last Name:MITRUSHINA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:18111 NORDHOFF ST
Mailing Address - Street 2:PSYCHOLOGY DEPARTMENT
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91330-0001
Mailing Address - Country:US
Mailing Address - Phone:818-677-2827
Mailing Address - Fax:818-677-2829
Practice Address - Street 1:18111 NORDHOFF ST
Practice Address - Street 2:PSYCHOLOGY DEPARTMENT
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91330-0001
Practice Address - Country:US
Practice Address - Phone:818-677-2827
Practice Address - Fax:818-677-2829
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10973103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist